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Quach ED, Franzosa E, Zhao S, Ni P, Hartmann CW, Moo LR. Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:242-257. [PMID: 37584150 DOI: 10.1080/01634372.2023.2246520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
Home and community-based services (HCBSs) such as home care and adult day centers are vital to supporting adults with dementia in community settings. We investigated whether HCBS use (use of both home care and adult day, use of one service, and use of neither service) varied between adults receiving care from three types of health-care teams with case management from social workers and nurses, and by comorbidity level, using 2019 data of 143,281 patients with dementia in the Veterans Health Administration. We compared HCBS use by patients' type of case-managed team (Home-Based Primary Care, geriatrics-based primary care, and dementia-focused specialty care) to patients in none of these teams, stratified by patients' non-dementia comorbidities (<4 or ≥4). Each type of health-care team was associated with both home care and adult day services, at each level of comorbidity. Home-Based Primary Care was most consistently associated with other forms of HCBS use, followed by Dementia Clinics and geriatrics-based primary care, for patients with ≥4 non-dementia comorbidities. Our findings suggest that case management in primary and specialty care settings is a contributor to the use of critical community supports by patients with the most complex needs.
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Affiliation(s)
- Emma D Quach
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System (152), Bedford, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Pengsheng Ni
- Health Law, Policy & Management, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
- Harvard Medical School, Neurology, Boston, Massachusetts, USA
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Stryczek KC, Honsberger M, Ball SL, Barnard JG, Young JP, Felker B, Au DH, Ho PM, Kirsh SR, Sayre GG. VA Outreach Is an Essential Area for Improving Veterans' Health Care Accessibility. Mil Med 2023; 188:e2439-e2447. [PMID: 36790439 DOI: 10.1093/milmed/usad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans' health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans' access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites' efforts to improve VHA outreach and veterans' experiences with access. MATERIALS AND METHODS This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff ("VHA staff") completed during 21 VHA medical center facility site visits between July and November 2017 and 48 telephone interviews with veterans completed between May and October 2018. Interviews and focus groups were transcribed and analyzed using deductive and inductive analysis to capture challenges and strategies to improve VHA health care access (VHA staff data), experiences with access to care (veteran data), barriers and facilitators to care (staff and veteran data), contextual factors, and emerging categories and themes. We developed focused themes describing perceived challenges, descriptions of VHA staff efforts to improve veteran outreach, and veterans' experiences with accessing VHA health care. RESULTS VHA staff and veteran respondents reported a lack of veteran awareness of eligibility for VHA services. Veterans reported limited understanding of the range of services offered. This awareness gap served as a barrier to veterans' ability to successfully access VHA health care services. Veterans described this awareness gap as contributing to delayed VHA enrollment and delayed or underutilized health care benefits and services. Staff focused on community outreach and engaging veterans for VHA enrollment as part of their efforts to implement the ChooseVA access initiative. Staff and veteran respondents agreed that outreach efforts were helpful for engaging veterans and facilitating access. CONCLUSIONS Although efforts across VHA programs informed veterans about VHA services, our results suggest that both VHA staff and veterans agreed that missed opportunities exist. Gaps include veterans' lack of awareness or understanding of VHA benefits for which they qualify for. This can result in delayed access to care which may negatively impact veterans, including those separating from the military and vulnerable populations such as veterans who experience pregnancy or homelessness.
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Affiliation(s)
- Krysttel C Stryczek
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Mark Honsberger
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Sherry L Ball
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Juliana G Barnard
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jessica P Young
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
| | - Bradford Felker
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - David H Au
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195-6522, USA
| | - P Michael Ho
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Susan R Kirsh
- The U.S. Department of Veterans Affairs Central Office, Washington, DC 20420, USA
| | - George G Sayre
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA 98195, USA
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Stroupe KT, Martinez R, Hogan TP, Gordon EJ, Gonzalez B, Tarlov E, Silva A, Huo Z, Kale I, Ippolito D, Osteen C, Jordan N, French DD, Gordon H, Fischer MJ, Smith BM. Health Insurance Coverage Among Veterans Receiving Care From VA Health Care Facilities. Med Care Res Rev 2021; 79:511-524. [PMID: 34622682 DOI: 10.1177/10775587211048661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reasons for acquiring insurance outside Department of Veterans Affairs (VA) health care coverage among VA enrollees are incompletely understood. To assess Veterans' decision-making and acquisition of non-VA health care insurance in the Affordable Care Act era, we used mailed questionnaires and semistructured interviews in a stratified random sample of VA enrollees <65 years in the Midwest. Of the 3,666 survey participants, 32.1% reported non-VA insurance. Frequently reported reasons included wanting coverage for emergency situations or family members. Those without non-VA insurance cited unaffordability as the main obstacle. Analysis of the semistructured interview data revealed similar findings. In multivariable logistic regression analyses, characteristics associated with non-VA insurance included higher income (>$50,000 vs. <$10,000, odds ratio [OR] = 5.95, 95% confidence interval [CI]: 3.45-10.3, p < .001). As financial barriers exist for acquisition of non-VA insurance and hence community care, it is critically important that VA enrollees' health care needs are met through VA or community providers financed through VA.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Loyola University Chicago, Maywood, IL, USA
| | - Rachael Martinez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Timothy P Hogan
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,The University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA
| | - Abigail Silva
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Loyola University Chicago, Maywood, IL, USA
| | - Zhiping Huo
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Ibuola Kale
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Dolores Ippolito
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Chad Osteen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
| | - Dustin D French
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
| | - Howard Gordon
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA.,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Michael J Fischer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,University of Illinois at Chicago, USA.,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, IL, USA.,Northwestern University, Chicago, IL, USA
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